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EXPERIMENTAL STUDY

A new dynamic three-dimensional digital color doppler method for quantification of pulmonary regurgitation: validation study in an animal model

Yoshiki Mori, MD^*, Rosemary A. Rusk, MD^*, Michael Jones, MD, Xiang-Ning Li, MD, PhD, Timothy Irvine, MD^*, Arthur D. Zetts and David J. Sahn, MD^*,*

^* Oregon Health and Science University, Portland, Oregon, USA
The Laboratory of Animal Medicine and Surgery, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
Philips Ultrasound, Bothell, Washington, USA

Manuscript received October 17, 2001; revised manuscript received April 22, 2002, accepted June 18, 2002.

^* Reprint requests and correspondence: Dr. David J. Sahn, The Clinical Care Center for Congenital Heart Disease, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L608, Portland, Oregon 97201-3098, USA.
sahnd{at}ohsu.edu

OBJECTIVES: The purpose of the present study was to validate a newly developed three-dimensional (3D) digital color Doppler method for quantifying pulmonary regurgitation (PR), using an animal model of chronic PR.

BACKGROUND: Spectral Doppler methods cannot reliably be used to assess pulmonary regurgitation.

METHODS: In eight sheep with surgically created PR, 27 different hemodynamic states were studied. Pulmonary and aortic electromagnetic (EM) probes and meters were used to provide reference right ventricular (RV) forward and pulmonary regurgitant stroke volumes. A multiplane transesophageal probe was placed directly on the RV and aimed at the RV outflow tract. Electrocardiogram-gated and rotational 3D scans were performed for acquiring dynamic 3D digital velocity data. After 3D digital Doppler data were transferred to a computer workstation, the RV forward and pulmonary regurgitant flow volumes were obtained by a program that computes the velocity vectors over a spherical surface perpendicular to the direction of scanning.

RESULTS: Pulmonary regurgitant volumes and RV forward stroke volumes computed by the 3D method correlated well with those by the EM method (r = 0.95, mean difference = 0.51 ± 1.89 ml/beat for the pulmonary regurgitant volume; and r = 0.91, mean difference = –0.22 ± 3.44 ml/beat for the RV stroke volume). As a result of these measurements, the regurgitant fractions derived by the 3D method agreed well with the reference data (r = 0.94, mean difference = 2.06 ± 6.11%).

CONCLUSIONS: The 3D digital color Doppler technique is a promising method for determining pulmonary regurgitant volumes and regurgitant fractions. It should have an important application in clinical settings.

Abbreviations and Acronyms   ACM   automated cardiac flow measurement   ECG   electrocardiogram   electrocardiographic   EM   electromagnetic   PA   pulmonary artery   PR   pulmonary regurgitant/regurgitation   RV   right ventricle/ventricular   RVOT   right ventricular outflow tract   SGI   Silicon Graphic Inc.   2D   two-dimensional   3D   three-dimensional   TOF   tetralogy of Fallot

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